There’s been a lot of important discussion about brain health, and for good reason.
1 in 8 persons worldwide live with mental illness; in the USA this is 1 in 5 adults. Less than half receive treatment and up to 1/3 will end up developing a substance abuse disorder in an attempt to cope. Our traditional means of receiving therapy and medication is reported to be less than 50% effective. So additional support for this population is sorely needed.
Mental health challenges have reaches crises levels in a number of nations. With current standard of care being difficult to access for some and ineffective for others, I maintain that we need radical shifts in a multitude of different areas of modern life to sufficiently address this. Our nutrition is one such facet that can make a profound impact. I am not of course stating that food is the sole answer, but I strongly believe it can have positive impacts on existing standard of care, from improved absorption of medications to increased emotionally resiliency to make needed changes.
Our mental health issues stem from a mix of genetic and environmental factors. Nutrition is among those modifiable environmental factors. Our brain uses up a massive amount of the required energy we need each day and the nutrients we consume influence both the structure of the brain and how well it functions. A couple weeks ago in my stress and diabetes episode I discussed the impact on blood sugar on mood and brain fog and I also drew this same correlation in last week’s hydration episode. I’ve linked to these episodes in the resource area of the show notes. These are some examples of how what we consume can directly impact mood.
When it comes to nourishing the brain, the great news is that what’s good for your heart, bones, hormones, and other organs is also good for your brain. So we don’t need to do anything crazy fancy just for the brain and what you may be doing to address other health concerns may have the unintended consequence of also supporting a healthy brain today and as you age.
The Big Rocks: Hydration and Blood Sugar
The big rocks are going to be hydration and blood sugar balance.
The brain is 75% water and all metabolic processes in the water require water, right, so we do not want to down-regulate your mood and cognitive sharpness for more important tasks that need water. Go back and listen to that episode to find out how much you water you need to stay mentally sharp and healthy.
When it comes to managing metabolic health, I think this is where most of us are faltering. 49% of Americans – yes, nearly half – are walking around with chronically elevated blood sugar that puts them at risk for diabetes, and 11.6% of that population – as of 2021 – already is diagnosed as diabetic. I can tell you from where I sat during the pandemic, that diabetes diagnoses exploded during the last 4 years, so our most recent data will be significantly underreported for today’s numbers.
Energy excess, usually in the form of carbohydrate, is at the root of the majority of metabolic health disorders. Just like people from the TV show Hoarders are living in homes which are dangerously overfull, so too our our cells struggling to cope with life under the burden of what some call ‘energy toxicity’. More obvious symptoms are chronic inflammation, fatty liver, elevated fasting glucose levels, fatigue, weight gain and weight loss resistance, atherosclerosis, etc. This is literally the body accumulating plaque, fats, and sugars that it cannot get rid of.
While the bulk of people who struggle with these conditions are probably consuming more processed foods than their body can handle, I do see this happen when people consume an excess of energy from healthy sources as well. Or sometimes people transition from an unhealthy diet to a much healthier diet and do not see the results because the overall ratios of macros haven’t changed enough to allow the body to rid of the excess accumulation. The quality is higher, but the overall amount of some macros exceed what their struggling system can tolerate.
When your body cannot function well with the amount of carbohydrate it is receiving, your mood can take a direct hit. Extreme fluctuations in blood sugar can cause brain fog, drowsiness, mood swings, and anxiety. There are links in the research to inflammation from other diseases, such as autoimmune disease or diabetes, leading to an increase in mental health struggles as the brain becomes burdened with inflammatory cytokines that lead to mood changes. On a more extreme end, we see ketogenic diets having a long, successful history of treating seizures. It was the only treatment available prior to seizure medication and is still used for those who do not respond to medication. The field of nutritional psychiatry is also seeing positive outcomes in low carb or ketogenic diets in cases of schizophrenia and bipolar disorder. This is a very new area of exploration, and there is a lot that is not understood about why this works. Nor does it reliably work in all who try it. But it does reinforce the impact of glucose on brain health and offer additional options for some people.
Addressing blood sugar and hydration are two things we can do that can have a pretty immediate impact, so start here if you feel this applies to you.
The Brain and the Gut
Another area of impact on the brain is the gut. Most of our mood chemicals, called neurotransmitters, are actually made in the gut! We have gut feelings for a very real reason backed by science!
Anything which disrupts the health of the gut has the potential to impact your mood. There is abundant research showing the connection between gut disorders and mood disorders, which I am happy to expound upon in a future episode if you’d like. A diet that is lacking in lots of fiber and phytonutrients from vegetables and fruit does not support a healthy gut microbiome, and this can lead to alterations in the microbiota that increase inflammation and impact mood. Some foods, be they additives, or foods we are intolerant to, agitate the lining of the gut and trigger the immune system to respond, sending a cascade of inflammation that perpetuates gut disruptions and sends inflammatory cytokines all the way to the brain that can impact our mood.
I first experienced this fresh out of undergrad when i started practicing as a nutrition coach. One of my very first clients, who I will call Debbie, told me that wheat made her depressed, and she avoided it for this reason. This was about 5 years before going gluten-free really became a thing. I had never heard of this. No one in my undergrad program had ever discussed this. But I was 24 years old and knew I was inexperienced enough to know that I didn’t know a lot, so I never questioned this, but accepted it as true for her.
Later on, I discovered I also had a gluten intolerance. In a GF cooking class, I heard others talking about how eating bread would make them unable to recall their second language or do math problems, and how much better their brain worked when they avoided it.
Then, just a couple years later, an experience at a beer festival drove the point home in a very personal way. While I knew I was intolerant to wheat, I was struggling to avoid it 100%, which I am sure you can understand. It made me bloated and constipated, and that was uncomfortable, but some times there were situations I deemed justified having it. I had a friend visiting and we went to a beer festival where I had several samples of craft beer on what was probably an empty stomach, so absorption would have been rapid. A couple hours later, I had a completely uninstigated, severe crash in emotions that left me paranoid, weepy, and extremely confused. This never happened when I drank alcohol on an empty stomach. My friend told me it was probably the beer and I did not believe him. So he called his friend, who was a researcher, and she confirmed what he said and explained to me that the inflammation from the gluten in beer likely crossed the blood brain barrier and led to a significant drop in neurotransmitters. Coming from her, I accepted it and she explained it in a way I understood. When I recovered, I went to the research myself and learned what I did not have the curiosity to explore 8 years earlier, that gluten and other food intolerances can have massive impacts on our mental health.
Observational Studies Point to Different Dietary Patterns Having an Impact on Depression and Anxiety
If you have a risk of personal experience with depression, avoiding ultra-processed foods is an important step. A Brazilian study during the COVID pandemic noted that depression and anxiety scores were higher among those who consumed ultra processed foods versus those who consumed minimally processed foods.
I appreciate this study that much more because it came from Brazil, where access to adequate and nourishing food is part of their constitutional law and some food banks actually reject foods with an excess of sugar, salt and fat. This means that we cannot say this population is subjected to the same economic situation in the USA where economically disadvantaged, who are more likely to experience depression and anxiety, also live in a country where processed food is often cheaper than fresh. This is not the case in Brazil, so this confounding variable is not one we need to consider as muddying the water in the way we would have had it been conducted in the USA. That said, most research in this area does take into account the impact that socioeconomic status and education has on mood and other health outcomes and teases it out of the data before drawing conclusions.
Larger Norwegian population studies also show higher self-reported anxiety in those who consume more processed foods and less self-reported depression in those who consumed a healthier, more nutrient dense diet, defined as including more whole grains (rye, barley, oats), berries, root vegetables, wild fatty fish, cabbage and legumes (beans).
Intervention Studies Back This Up, and Highlight Key Nutrients of Concern
In looking at the impact of diet on mood, there are also some intervention studies that show a positive impact. Collective findings from various studies suggest a strong link between diet quality and depression. Healthier dietary patterns, particularly those resembling the Mediterranean diet, can significantly reduce depressive symptoms and improve overall mental health. These studies are often small in number and not as statistically powerful as observational studies, but they have a signal suggesting positive impact.
In the much talked about SMILES trial published in 2017, people in the middle of a major depressive episode met with either a dietitian for dietary support or received social support, basically by having trained personnel engage in neutral topics of interest with the participant or play board or card games. The objective here was to provide the same time and schedule of social interaction the dietary cohort received in an engaging and overall positive experience to negate the impact of positive social engagement itself on depression. Those in the dietary support group were supported in transition to a more Mediterranean diet and showed a decrease in symptoms, with remission of their depressive episode (defined as a MADRS score <10) being achieved in 32% of the dietary support group vs 8% of the control group receiving social support. That’s pretty damn significant.
A study in 101 young adults aged 17-35 with depressive symptoms showed a reduction in depression after just 3 weeks of dietary change. In this study, the dietary intervention cohort watched a short nutrition video and were given instructions to alter their diet to include 5 servings of veg and 2-3 fruits a day, 3 whole grain servings per day, 3 daily protein servings from lean meat and plant sources, with fish 3 times per week, 3 servings of unsweetened dairy daily, 3 tablespoons of nuts and seeds per day, and 2 tablespoons of olive oil per day as well as 1 teaspoon of anti-inflammatory spices (turmeric and cinnamon) on most days. They were also instructed to reduce consumption of refined carbohydrate, sugar, soft-drinks, and fatty or processed meats. A sample diet plan was also given, as well as some sample packs of nut butter, spices and olive oil to increase adherence. Adherence was ascertained at 3 weeks using a questionnaire and backed up by spectrophotometry, which uses light to measure carotenoid levels in the skin and therefore confirm or refute self-reported changes in produce intake. In just 3 weeks, participants in the diet group reported significant dietary changes confirmed by the spectrophotometer that was not reported nor seen in the control group. They also reported significantly lower depression scores than they had 3 weeks earlier, which were maintained at a 3 month follow-up phone call.
Nutrients that Impact Mood
There’s a great deal of research out there on this, and when dialing down to key nutrients that are helpful, those antioxidants in veggies appear to play a role, as do fish oils. A Turkey study of inpatients at a mental health center reported low dietary intake of vitamins A, B6, B12, C, folate, and minerals like magnesium and zinc. Blood levels of folate and B12 showed lower serum levels in depressed individuals than the baseline control group and the depressed cohort also reported low intake of both fish and produce.
Looking closer at these nutrients, we can see the role they play in brain health. Produce and fish oils are very anti-inflammatory and can reduce inflammatory compounds in the body which disrupt neurotransmitters in the brain like dopamine, serotonin and GABA. All B vitamins play a role in creating and balancing our neurotransmitters. Magnesium plays a role in neurological health and magnesium deficiency can lead to depression due to insufficient availability for brain neurons. There are case studies in the literature of depression being alleviated with magnesium, fish oil, or folate supplementation alone.
Iron deficiency is also impactful in mood, as it is essential for production of dopamine, serotonin, and norepinephrine and it delivers oxygen to the brain! It also is needed to mylienate neurons, and along with magnesium deficiency our neurons struggle when we are deficiency.
It would behoove health practitioners to test for these nutrient deficiencies when working with patients struggling with depression, especially when B vitamin and iron intake is lacking in so much of the population.
Now, I don’t want to spend all my time sharing research papers with you, so if you are one of those people who likes to go spelunking in Pubmed, be sure to head over to my Substack where you can access all the research I looked at in putting this episode together.
The potential impact of this additive blew my mind!
However, before I move on, I want to highlight a study on one specific aspect of processed foods that has an impact on mood that is not often looked at, and that is artificial sweeteners.
There is some research suggesting that artificial sweeteners can impact mood and aggravate depressive symptoms in people as well as rodents, so that is something to consider if you consume a great deal of sugar-free products and struggle with low mood or depressive symptoms. This is most studied with aspartame, which is known as Equal or Nutrasweet on the market, but as aspartame on ingredient labels. One study I found from 1993 really was rather surprising, and its hard to be surprised by research nowadays. A double-blind study from 1993 I found intended to look at 40 individuals, but the International Review Board halted the study after 13 people completed it because the severity of depressive responses in those with a history of depression was so severe.
In this double-blind study, people were given 30mg aspartame per kg body weight. I crunched the numbers on this for reference, and this equates to 1800 mg for a 60kg/130 pound person and 2700 mg for a 90kg/200 pound person. A can of diet soda contains about 200mg of aspartame so we are looking at the risk of severe symptoms being more prevalent in heavy diet soda drinkers who drink 8 cans a day or more or in children, who are physically much smaller than most adults.
What the study could not ascertain, and what will probably never be ascertained due to ethical concerns going forward, is whether or not smaller, more typically consumed doses of aspartame impact those with a predisposition to depression, but to a lesser degree that is easier to overlook but still significant enough to impact quality of life.
I will also suggest that we be extra conservative about giving our kids aspartame in an attempt to reduce their sugar intake, as this may be trading one problem for another, particularly if there is a family history of depression. Aspartame is also implicated in research to increase seizure activity in children with epilepsy and in animal models, but there is also research showing no correlation, so we cannot definitively say it is so. This is one area where each person needs to take their own health history and health goals to make the best decision for them when it comes to artificial sweeteners and their brain. I will also point out that it is strictly aspartame as the culprit in this research, and I did not look at any other common non-caloric sweetener out there. However, more recent research on ultra-processed food and the risk of depression from 2023 still suggests that artificially sweetened beverages still lead to more significant depressive symptoms so the newer brands may not be better.
Simple Strategies to Rethink Your Plate
So we’ve taken a look at the impact of ultra processed foods and nutrient depletion on the brain. When we rely more on processed foods, we get less nutrients needed to support brain health and we increase consumption of compounds that may directly aggravate inflammation through gut changes and additives which impact mood.
It is probably not realistic for most of us to go on a full-on unprocessed diet, but focusing on making more choices that support brain health will crowd out problematic foods and have the bonus of putting a positive framework around the whole project. Moving forward, you are eating to support your brain, not avoiding things which are “bad for your brain”.
A diet made up mostly of foods your pre-WWII ancestors would have recognized comes with more vitamins and minerals that keep the brain healthy and usually have a lower glycemic load, so that crazy spike and crash in glucose that impacts mood is less likely to be a problem. Additionally, the antioxidants and fiber in these foods are going to have a very positive impact on the gut microbiome and these foods lack stabilizers, gums, and additives which can irritate the gut lining, leading to chronic inflammation and microbiome dysfunction via gut irritation.
To make it easier to choose Better Foods for your Brain:
Ask yourself if your depression era grandmother (however many greats back she would have been) would have prepared this food for the family. If she would not have recognized it, strive to make it a rarely to sometimes food rather than a common food in your cupboard. Note there are some things which might be tricky, like bread. If bread was a part of your family culture, your ancestors probably made it by hand with water, yeast and flour, so it isn’t a plastic-wrapped store bought bread with stabilizers.
Begin asking your body how it feels about your food choices. Are there foods which make you feel sluggish or meals which give you brain fog? You may want to start staying away from them! Also, practice mindfulness and body awareness during your meals. Noticing when your body is full as well as when it is hungry can help you to avoid overconsumption of even healthy foods.
Choose boxed foods with fewer ingredients, and ingredients you recognize. Some degree of processing is largely unavoidable in the modern world, so when it comes in a box, look for few ingredients, and ingredients which are recognizable.
I will say this time and time again – when sourcing your meals, ask yourself two questions: where is my produce? Where is my protein? These two questions will allow you to find the foods which support stable blood sugar and offer more nutrients per bite to support neurotransmitter and gut health.
Stay hydrated! This is easy and cheap. Drink water, herbal teas, and other hydrating fluids until your urine is pale yellow. If you hate the taste of water, try adding frozen berries or pair slices of your favorite citrus fruit with herbs such as mint, rosemary or even basil and make your own spa water!
I want to conclude this episode by thanking listener Katie White for sharing the original economist article that inspired this podcast. That is found in the show notes.
Please restack this episode to help others feel more empowered to support their mental health and increase awareness on the impact our food choices have on not just our body, but our minds.
I do hope that today’s episode has been not just informative, but also has empowered you to invest in your brain health! If you struggle implementing some of the strategies I discussed that are necessary to feed to your brain well, click on the link that says Work with Aimee in the resources section below and schedule a free call to discuss your concerns. Together we can create a truly customized plan to support your health goals that you can sustain for the long haul.
Resources:
Many mental-health conditions have bodily triggers. (2024, April 24). The Economist. https://www.economist.com/science-and-technology/2024/04/24/many-mental-health-conditions-have-bodily-triggers
Jaqua E, Biddy E, Moore C, Browne G. The Impact of the Six Pillars of Lifestyle Medicine on Brain Health. Cureus. 2023 Feb 3;15(2):e34605. doi: 10.7759/cureus.34605. PMID: 36883088; PMCID: PMC9985951. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985951/
Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc. 2017 Nov;76(4):427-436. doi: 10.1017/S0029665117002026. Epub 2017 Sep 25. PMID: 28942748.
Samuthpongtorn C, Nguyen LH, Okereke OI, Wang DD, Song M, Chan AT, Mehta RS. Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023 Sep 5;6(9):e2334770. doi: 10.1001/jamanetworkopen.2023.34770. Erratum in: JAMA Netw Open. 2023 Oct 2;6(10):e2341346. doi: 10.1001/jamanetworkopen.2023.41346. PMID: 37728928; PMCID: PMC10512104.
Coletro HN, Mendonça RD, Meireles AL, Machado-Coelho GLL, Menezes MC. Ultra-processed and fresh food consumption and symptoms of anxiety and depression during the COVID – 19 pandemic: COVID Inconfidentes. Clin Nutr ESPEN. 2022 Feb;47:206-214. doi: 10.1016/j.clnesp.2021.12.013. Epub 2021 Dec 20. PMID: 35063203; PMCID: PMC8710821.
Siqueira KB, Borges CA, Binoti ML, Pilati AF, da Silva PH, Gupta S, Drewnowski A. Nutrient density and affordability of foods in Brazil by food group and degree of processing. Public Health Nutr. 2021 Oct;24(14):4564-4571. doi: 10.1017/S1368980020004358. Epub 2020 Oct 28. PMID: 33109278; PMCID: PMC10195327.
Jacka FN, O’Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, Castle D, Dash S, Mihalopoulos C, Chatterton ML, Brazionis L, Dean OM, Hodge AM, Berk M. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017 Jan 30;15(1):23. doi: 10.1186/s12916-017-0791-y. Erratum in: BMC Med. 2018 Dec 28;16(1):236. doi: 10.1186/s12916-018-1220-6. PMID: 28137247; PMCID: PMC5282719.
Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. PLoS One. 2019 Oct 9;14(10):e0222768. doi: 10.1371/journal.pone.0222768. PMID: 31596866; PMCID: PMC6784975.
Kaner, G., Soylu, M., Yüksel, N., Inanc, N., Ongan, D., & Başmısırlı, E. (2015). Evaluation of Nutritional Status of Patients with Depression. BioMed Research International, 2015. https://doi.org/10.1155/2015/521481.
Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry. 2005 Nov 1;58(9):679-85. doi: 10.1016/j.biopsych.2005.05.009. Epub 2005 Jul 25. PMID: 16040007; PMCID: PMC4288963.
Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70. doi: 10.1016/j.mehy.2006.01.047. Epub 2006 Mar 20. PMID: 16542786.
Walton, R., Hudak, R., & Green-Waite, R. (1993). Adverse reactions to aspartame: Double-blind challenge in patients from a vulnerable population. Biological Psychiatry, 34, 13-17. https://doi.org/10.1016/0006-3223(93)90251-8.
Camfield, P., Camfield, C., Dooley, J., Gordon, K., Jollymore, S., & Weaver, D. (1992). Aspartame exacerbates EEG spike‐wave discharge in children with generalized absence epilepsy. Neurology, 42, 1000 – 1000. https://doi.org/10.1212/WNL.42.5.1000.
Humphries, P., Pretorius, E., & Naudé, H. (2008). Direct and indirect cellular effects of aspartame on the brain. European Journal of Clinical Nutrition, 62, 451-462. https://doi.org/10.1038/sj.ejcn.1602866.
